Posted by cache-monkey on December 6, 2005, at 21:31:14
In reply to Tell me about dopamine agonists for depression, posted by blueberry on December 4, 2005, at 15:23:37
I've also been thinking about a dopaminergic antidepressant. Based on what I've dug up (based on abstracts and people's posts here on pbabble), I haven't seen any reports on actual long-term efficacy for any of the drugs you mention. This could, however, be a matter of people not reporting back when something actually works. In any case, here's a summary of what I've gathered:
* Amantadine - Mostly studied as adjunctive for treatment-resistant depression, SSRI sexual dysfunction, and Zyprexa weight gain. I can't seem to find much in terms of its monotherapeutic antidepressant/anhedonic properties. Based on what I've read on pbabble, I think that most people find this somewhat of a dud as monotherapy, and a minority ended up feeling worse.
* Mirapex - The only one that has been really clinically studied (mostly for BP depression) out of the list you give. Some people on pbabble have reported a great initial response. For those who have posted about their long-term experience, most seem to report getting really tired after a while on the med. So this might be evidence of poop-out, but I'm wondering this is just a matter of who's reporting back.
* Bromocriptine - I've found at least one study indicating a strong AD profile for bromo monotherapy (it was = to imipramine). There are also some studies showing it beneficial for stopping smoking. (For me nicotine has been a way of self-medicating anhedonia, as well as anxiety.) I've read about a handful of people with postive reponses, but most (like TenMan) have gone off of it due to some side effect, usually rhinitis. I have no idea about long-term efficacy.
I've been running through the dopamine options with my pdoc, who I respect a lot. He was actually most hip about low-dose selegiline... (well, actually with the option of heading up to non-MAO-B-selective doses). Have you thought about that as an option? I know that patch is delayed until late Feb, but there's still the old-fashioned oral route.
The limiting side effect here seems to be insomnia, but this is dose dependent. I have read posts by a number of people who have stayed on selegiline at some dose that they could tolerate for quite a while, maintaining a positive response. Many have had to go up to higher standard-AD doses, but a few seem to get something positive out of the low MAO-B selective dose range.
I actually have a scrip for selegiline (up to 10 mg/day, which is pretty low) that I'm about to fill. I don't know if I'm going to start right away because I'm trying to adjust my benzo downward. But if/when I do, I will keep the group posted.
Good luck with your search for a dopaminergic. I'll look forward to reading about which direction you end up heading.
Best,
cache-monkey> My symptoms are apathetic anhedonic depression. Antidepressants keep me an inch above the suicidal range or make me worse. I respond real well to dopamine enhancers, but alas, only for a very short time. Ritalin, adderall, the little bit of dopamine reuptake in zoloft, cymbalta, or wellbutrin, only provides benefits for a couple days before tolerance sets in. Same with amisulpride. Probably the most effective might be ritalin or adderall, but I know where that road leads...tolerance, increased doses, increased side effects, eventual ineffectiveness.
>
> So I'm wondering...amantadine, pramipexole, bromocriptine. If..and I understand that is a big if...a dopamine agonist works for someone, would it keep working for a long time? Or would it poop out quickly like other dopamine meds?
>
> Any thoughts?
poster:cache-monkey
thread:585415
URL: http://www.dr-bob.org/babble/20051203/msgs/586282.html